Key Takeaways:

• Medicare Part A covers inpatient hospital stays, but there are several critical gaps, including long-term care, routine dental and vision, and custodial care.

• Understanding what Medicare Part A does not cover helps you budget for out-of-pocket costs and explore supplemental insurance or savings strategies.

What Medicare Part A Leaves Out—and Why It Matters for Your Budget

Medicare Part A is an essential piece of your healthcare coverage, especially if you’re over 65 or meet certain eligibility criteria. It takes care of hospital stays, skilled nursing care, and some home healthcare services. However, there are several areas it does not cover, and those gaps can have a significant impact on your out-of-pocket costs. Knowing what isn’t included can help you plan better and avoid unexpected expenses.

Long-Term Care: The Biggest Medicare Part A Exclusion

One of the most common misconceptions about Medicare Part A is that it pays for long-term care in a nursing home or assisted living facility. In reality, it only covers short-term skilled nursing care under very specific conditions.

What Is Covered?

• If you’ve had a hospital stay of at least three days and require rehabilitation or skilled nursing care, Medicare Part A covers up to 100 days in a skilled nursing facility.

• Coverage decreases over time, with full coverage for the first 20 days, followed by daily copayments for days 21-100.

• After day 100, you are responsible for the full cost.

What Isn’t Covered?

• Custodial care (help with daily activities like bathing, dressing, and eating) is never covered.

• Assisted living facilities and nursing home stays beyond 100 days are not paid for by Medicare Part A.

How This Affects Your Budget

Without coverage for long-term care, you may need to rely on personal savings, Medicaid (if you qualify), or long-term care insurance. The cost of a nursing home stay can reach thousands of dollars per month, making it one of the most expensive healthcare needs in retirement.

Routine Dental, Vision, and Hearing Care Are Not Included

Many people assume Medicare Part A includes routine check-ups for teeth, eyes, and ears. Unfortunately, these services are not covered under Part A.

What Is Covered?

• If you require hospitalization due to an emergency dental procedure or surgery involving your eyes or ears, Part A may help pay for the hospital stay.

What Isn’t Covered?

• Routine dental exams, cleanings, and fillings

• Dentures and implants

• Routine eye exams and prescription glasses

• Hearing exams and hearing aids

How This Affects Your Budget

Out-of-pocket costs for dental, vision, and hearing services can add up quickly. Many people either pay for these services themselves or look into standalone insurance plans that cover them.

Prescription Drug Coverage Is Not Included

While hospital-administered medications during an inpatient stay are generally covered, Medicare Part A does not pay for most outpatient prescription drugs.

What Is Covered?

• Medications given during a hospital stay as part of inpatient treatment.

What Isn’t Covered?

• Most prescription drugs taken at home

• Long-term maintenance medications for conditions like diabetes, high blood pressure, or cholesterol

How This Affects Your Budget

Since Part A does not cover outpatient prescriptions, you’ll need a Medicare Part D plan or another form of prescription drug coverage. Otherwise, you’ll pay full price for your medications.

Medicare Part A Doesn’t Cover Care Outside the U.S.

If you’re planning to travel outside the United States, be aware that Medicare Part A typically does not cover hospital stays in foreign countries.

What Is Covered?

• In very limited cases, Medicare Part A may pay if you experience a medical emergency while traveling through Canada to or from Alaska or if you require care at a foreign hospital that is closer than a U.S. facility.

What Isn’t Covered?

• Routine hospital stays abroad

• Emergency care in most international locations

How This Affects Your Budget

If you frequently travel outside the country, you may want to consider additional travel health insurance to avoid expensive overseas medical bills.

Private Hospital Rooms and Additional Comforts

Medicare Part A covers a semi-private hospital room during inpatient care. If you prefer a private room, you’ll likely have to pay for it yourself.

What Is Covered?

• A semi-private room, which means you’ll share with another patient unless medically necessary.

• Meals, nursing services, and necessary medications while hospitalized.

What Isn’t Covered?

• Private rooms (unless required for medical reasons)

• Television, phone, and other hospital amenities

How This Affects Your Budget

If you prefer a private room or additional hospital comforts, you may need to pay for these luxuries out-of-pocket.

Home Health Care Coverage Has Limits

Medicare Part A provides some coverage for home health care, but it comes with strict eligibility requirements.

What Is Covered?

• Part-time skilled nursing care or therapy when prescribed by a doctor.

• Intermittent home health services following a hospital stay.

What Isn’t Covered?

• 24/7 home care or personal care assistance

• Long-term in-home care services

How This Affects Your Budget

If you need ongoing home health care or personal assistance, you’ll need to pay for these services out-of-pocket or look for alternative coverage options.

Planning for the Gaps in Medicare Part A

Now that you know what Medicare Part A does not cover, it’s essential to plan ahead for potential expenses. Here are a few strategies to help reduce your out-of-pocket costs:

• Consider additional insurance: A Medigap (Medicare Supplement) plan or Medicare Advantage plan might cover some of these gaps.

• Budget for uncovered costs: Set aside savings for dental, vision, hearing, long-term care, and other uncovered services.

• Explore Medicaid eligibility: If you have limited income, Medicaid may help cover long-term care or other expenses.

• Look into alternative assistance programs: Some state and nonprofit programs help with prescription costs, home care, and medical travel expenses.

By understanding what Medicare Part A doesn’t cover, you can avoid unexpected costs and plan your healthcare budget more effectively.

What You Can Do to Protect Your Healthcare Budget

Medicare Part A is a solid foundation for hospital coverage, but it doesn’t cover everything. Gaps in coverage—especially for long-term care, routine services, and outpatient medications—mean you may face significant out-of-pocket expenses. By planning ahead, exploring supplemental coverage, and setting aside savings, you can ensure that you’re financially prepared for your healthcare needs.